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首页> 外文期刊>Emerging themes in epidemiology >The effect of improved rural sanitation on diarrhoea and helminth infection: design of a cluster-randomized trial in Orissa, India
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The effect of improved rural sanitation on diarrhoea and helminth infection: design of a cluster-randomized trial in Orissa, India

机译：改善农村卫生条件对腹泻和蠕虫感染的影响：印度奥里萨邦一项整群随机试验的设计

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Background Infectious diseases associated with poor sanitation such as diarrhoea, intestinal worms, trachoma and lymphatic filariasis continue to cause a large disease burden in low income settings and contribute substantially to child mortality and morbidity. Obtaining health impact data for rural sanitation campaigns poses a number of methodological challenges. Here we describe the design of a village-level cluster-randomised trial in the state of Orissa, India to evaluate the impact of an ongoing rural sanitation campaign conducted under the umbrella of India’s Total Sanitation Campaign (TSC).We randomised 50 villages to the intervention and 50 villages to control. In the intervention villages the implementing non-governmental organisations conducted community mobilisation and latrine construction with subsidies given to poor families. Control villages receive no intervention. Outcome measures include (1) diarrhoea in children under 5 and in all ages, (2) soil-transmitted helminth infections, (3) anthropometric measures, (4) water quality, (5) number of insect vectors (flies, mosquitoes), (6) exposure to faecal pathogens in the environment. In addition we are conducting process documentation (latrine construction and use, intervention reach), cost and cost-effectiveness analyses, spatial analyses and qualitative research on gender and water use for sanitation. Results Randomisation resulted in an acceptable balance between trial arms. The sample size requirements appear to be met for the main study outcomes. Delays in intervention roll-out caused logistical problems especially for the planning of health outcome follow-up surveys. Latrine coverage at the end of the construction period (55%) remained below the target of 70%, a result that may, however, be in line with many other TSC intervention areas in India. Conclusion We discuss a number of methodological problems encountered thus far in this study that may be typical for sanitation trials. Nevertheless, it is expected that the trial procedures will allow measuring the effectiveness of a typical rural sanitation campaign, with sufficient accuracy and validity.
机译：背景技术与卫生条件差相关的传染病，例如腹泻，肠蠕虫，沙眼和淋巴丝虫病，继续在低收入环境中造成巨大的疾病负担，并极大地增加了儿童的死亡率和发病率。为农村卫生运动获取健康影响数据提出了许多方法上的挑战。在这里，我们描述了印度奥里萨邦村级集群随机试验的设计，以评估在印度全面卫生运动（TSC）的保护下正在进行的农村卫生运动的影响。我们将50个村庄随机分配给干预和50个村庄进行控制。在干预村中，执行中的非政府组织在向贫困家庭提供补贴的情况下进行了社区动员和厕所建设。管制村没有任何干预。结果措施包括：（1）5岁以下儿童和所有年龄的腹泻;（2）由土壤传播的蠕虫感染;（3）人体测量学措施;（4）水质;（5）昆虫媒介（苍蝇，蚊子）的数量; （6）暴露于环境中的粪便病原体。此外，我们正在进行过程文档（厕所的建设和使用，干预范围），成本和成本效益分析，空间分析以及关于卫生用水性别和用水的定性研究。结果随机化导致试验组之间的可接受的平衡。主要研究结果似乎满足了样本量要求。推迟推出干预措施会导致后勤问题，特别是在计划健康结果随访调查时。施工期结束时厕所的覆盖率（55％）仍低于70％的目标，但是这一结果可能与印度的其他TSC干预领域相符。结论我们讨论了迄今为止在这项研究中遇到的许多方法学问题，这些问题对于环卫试验可能是典型的。尽管如此，预计该试验程序将能够以足够的准确性和有效性来衡量典型的农村环卫运动的有效性。

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